1. Metronomic therapy is an effective salvage treatment for heavily pre-treated relapsed/refractory multiple myeloma.
- Author
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Papanikolaou X, Szymonifka J, Rosenthal A, Heuck CJ, Mitchell A, Johann D Jr, Keller J, Waheed S, Usmani SZ, Van Rhee F, Bailey C, Petty N, Hoering A, Crowley J, and Barlogie B
- Subjects
- Adult, Aged, Aged, 80 and over, Cisplatin administration & dosage, Dexamethasone administration & dosage, Doxorubicin administration & dosage, Female, Follow-Up Studies, Humans, Male, Middle Aged, Survival Rate trends, Thalidomide administration & dosage, Treatment Outcome, Administration, Metronomic, Multiple Myeloma drug therapy, Multiple Myeloma mortality, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local mortality, Salvage Therapy methods
- Abstract
Relapsed/refractory multiple myeloma represents a major challenge in multiple myeloma therapy. For patients with relapsed/refractory multiple myeloma, we developed a treatment schema of metronomically scheduled drug therapy. We identified 186 patients who had been treated with metronomic therapy between March 2004 and January 2012 with a median follow up of 24.2 months. Median age was 61 years (range 36-83). Median number of prior therapies was 14 (range 1-51). Median number of completed metronomic therapy cycles was 1 (range 1-5), while 45 of 186 (25%) received 2 or more cycles. Responses included complete remission in 11 of 186 patients (6%), very good partial remission in 12 of 186 (7%), partial remission in 65 of 179 (36%), and minimal response in 29 of 186 (16%), for an overall response rate of 63% (117 of 186). Median overall survival and progression-free survival were 11.2 and 3.6 months, respectively. Hematologic toxicity grading was problematic as 146 of 186 (78%) of patients presented with at least grade 2 thrombocytopenia within 90 days prior to starting metronomic therapy. Grade 4 leukopenia, anemia, and/or thrombocytopenia following metronomic therapy occurred in 108 of 186 (58%), 12 of 186 (6%), and 147 of 186 (79%) patients, respectively. Incidence of grade 3-4 neutropenic fever was 4 of 186 (2%). Most patients (177 of 186, 95%) were treated in an outpatient unit and secondary admissions due to regimen-related toxicity occurred in 37 of 186 (20%). Treatment-related mortality was evident in 2 of 186 (1%). In conclusion, metronomic therapy is an effective late salvage treatment in relapsed/refractory multiple myeloma, with a high overall response rate and a favorable toxicity profile.
- Published
- 2013
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